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Sidney Kimmel Comprehensive Cancer Center
Report 2011
William G. Nelson, M.D., Ph.D.Director
New Directions for the SKCCC and its Research Programs: Three Examples
(why I am excited to be SKCCC Director)
• Individualized Health/Personalized Cancer Medicine - now a University-wide objective
• Initiative to eliminate cancer disparities
• Establishment of a Palliative Care capability for SKCCC and Johns Hopkins Medicine
11 colorectal cancers11 breast cancers24 pancreas cancers22 gliomas22 meduloblastomas
2 leukemias1 breast cancer
1 breast cancer4 granulosa cell tumors
1 lung cancer Sanger1 melanoma
*Vogelstein B AACR Annual Meeting (2010)
WashingtonUniversity
British ColumbiaCancer Research
Centre
Sanger InstituteScience, Feb 16, 2001
Whole Exome Sequences of 100 Human Cancers*
3142 mutated genes286 tumor suppressors33 oncogenes
SKCCC
Hypermethylation(versus normal
tissues)
Hypomethylation(versus normal
tissues)
Genome-Wide Epigenetic Alterations inMetastases from Men Dying of Prostate Cancer*
*Yegnasubramian S,Aryee MJ et al. (2011)
Biomarker Discoveries
Biomarker Assay Platforms
Regulatory/Systems Considerations
Integration into Clinical PracticeTest Marker Specimen Company Disease Indication
PCA3 RNA urine Dianon prostate cancer
predicts prostate biopsy outcome
MGMTmethylation
DNA tissue MDxHealth glioblastoma predicts responseto temozolomide
GSTP1methylation
DNA urinetissue
LabCorpMDxHealth
prostatecancer
predicts prostate biopsy outcome
AMACR protein tissue many prostatecancer
diagnosis aid
DNA Beaming, PARE,MSP, nanoMSP, MOB, COMPARE, GEMINI
germline DNA variantssomatic DNA mutations, translocations, etc.somatic DNA somatic methylation changesRNA expression changes, splice variantsprotein expression changes
CLIA, biospecimen collection/archiving, HIPAA, health recordinformation technology
Translational Development of Molecular Biomarkers at SKCCC: What are the
Challenges?
Detection of Cancer-Specific Mutations in Blood and Body Fluids: Opportunity
for Screening and Early Detection*
*Diehl F et al. Gastroenterology 135: 489-98 (2008)
colon cancer stage
% m
utan
t DN
A in
sto
ol
“BEAMing” for mutant DNA
Unmet medical needs: • poor colonoscopy quality• timing of repeat colonoscopy
Improving Cancer Health at a Population Scale:Covered Lives in the
Johns Hopkins Health SystemOrganization
(Characteristics)Population Size
Johns Hopkins Community Physicians (Primary Care Provider Network)
>260,000
Johns Hopkins Priority Partners(Medicaid Health Maintenance Organization)
>185,000
Johns Hopkins Employee Health Program(Health Insurance Plan)
>50,000
Johns Hopkins US Family Health Plan(Provider to US Government and Military Employees and Families)
Enrolling
Cancer Prevention and Control Program members already working with these entities to establish cancer screening guidelines and improve screening performance- first project focuses on reducing over-screening for prostate cancer among elderly men
Individualized Health/Personalized Medicineat SKCCC and at Johns Hopkins MedicineWhat are the Challenges/Opportunities?
Individualized Health Initiative (IHI) Planning led by Provost, Dean of Engineering, and SKCCC Director
Envisioned $1.5B project (>$0.5B investment in Epic health record/management system-investment in research information technology needed)
Brings together Schools of Medicine, Public Health, Engineering, Nursing, Arts & Sciences, Business, Applied Physics Laboratory
$30M Malone gift to Engineering
$30M Commonwealth Foundation gift to SKCCC for Personalized Cancer Medicine
Informationfor Health
LearningCommunities
for Health
Laboratory forAdvanced
Biotechnologiesfor Health
OrganizationalModel for
Affordable Health
Design andDeploy NewResearch
Information System
Develop BioethicsFramework
Design New Approach for Clinical Trials
Build NetworkThroughout
Johns HopkinsHealth System
Develop BetterMeasurements,
Diagnostics,and Treatments
• Epigenome/Genome Core
• High PerformanceComputing Core• Statistics Core• Biorepository
Apply IHIPrinciples,
Methods, and Tools to
Population Health at
Significantly Lower Cost
IHIDirector’s Office
AppliedPhysics
Laboratory
JohnsHopkins
University JohnsHopkinsMedicine
Race, Ethnicity, and Cancer Mortalityin the SKCCC Catchment Area (2010)
Race Category
Gender Category
Cancer Incidence
%
SKCCC Cancer Registrants
%
White
Male 39.4 43.3
Female 38.0 32.3
Total 77.4 75.6
Black
Male 9.1 9.6
Female 9.0 10.0
Total 18.1 19.6
Other
Male 2.3 2.3
Female 2.2 2.5
Total 4.5 4.8
• Maryland cancer problem 2nd rank state/district in
cancer mortality in 1985 Cancer disparities in
African-Americans were a major contributor to poor cancer outcomes
Disparities were particularly evident in colorectal, prostate, lung, and breast cancers
CONFERENCE CHAIRPERSON:William G. Nelson, Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore, MD
Working to Eliminate Cancer Health Disparities:Committed Leadership
Brian Gibbs, PhD/MPA, Associate Deanfor Diversity and Cultural Competence
Johns Hopkins Medicine Diversity and Inclusion
Plan 2020
• 20% of 200 Hopkins leaders under-represented minorities
• 75% of community residents view Hopkins as ‘trusted partner’
Office of Diversity and Cultural Competence
at SKCCC
at Johns Hopkins Medicine
Working to Eliminate Cancer Health Disparities:Committed Partners: State of Maryland
Comprehensive Cancer Control Plan
• High cancer mortality in Maryland prompted issuance of Cancer Control Plans; 2004 was first Comprehensive Cancer Control Plan
• SKCCC and University of Maryland Greenebaum Cancer Center have contributed to the Comprehensive Cancer Control Plans
• Cancer mortality among African-Americans and disparities are falling
New Maryland Comprehensive Cancer Control Plan introduced at SKCCC in summer of 2011
SKCCC Research Helps Eliminate Disparities in Cancer Treatment*
Opportunity: Allogenic bone marrow transplantation (alloBMT) has proven benefit in the treatment of hematological malignancies and inherited bone marrow disorders.
Challenge: HLA-matched bone marrow donors are under-represented among African-American and other minority populations.
Solution: Innovative strategy for establishing immune tolerance in bone marrow allograftsreduces graft-versus-host disease (GVHD) and making alloBMT more accessible to minority patients.
*Brunstein CG et al. Blood 118: 282-288 (2011)
Individualizing the Care of Patientswith Advanced Cancers:
the Role of Palliative Care*
SKCCC Director and Administrator led in the establishment of a Palliative Care Program for all of Johns Hopkins Medicine
$3M investment in new faculty, facilities, research
National search identified Thomas J. Smith, M.D., as inaugural Director
Planned SKCCC Space Expansion
Suburban Hospital:7,000 ft2
Sibley Hospital: 30,000 ft2
All Children’s Hospital: 46,800 ft2
Bayview Campus: 25,000 ft2
• New Faculty (8 positions)
• Radiation Oncology
• Medical Oncology
• Pulmonary
• Clinical space- 20,000 ft2; Laboratory/support space-5,000 ft2
Sidney Kimmel Comprehensive Cancer Center
Report 2011
William G. Nelson, M.D., Ph.D.Director
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